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What supports mothers of very preterm babies to start and continue breast milk feeding neonatal units? A qualitative COM-B analysis of mothers' experiences. 是什么支持早产儿母亲在新生儿病房开始并继续母乳喂养?对母亲经验的定性 COM-B 分析。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-06 DOI: 10.1186/s12884-024-06910-4
Jenny McLeish, Annie Aloysius, Chris Gale, Maria A Quigley, Jennifer J Kurinczuk, Fiona Alderdice

Background: It is challenging for mothers who give birth very preterm to produce sufficient breast milk by expressing for weeks before their baby is able to feed from the breast, and then to transition from tube feeding to breastfeeding. Lactation is most successful when stimulated shortly after birth, established within 72 h, and maintained by expressing 6-8 times a day. This study explored mothers' experiences of how breast milk feeding and breastfeeding for very preterm babies can be supported by staff and the facilities of a neonatal unit.

Methods: Twenty-three mothers of very preterm babies were interviewed, from four neonatal units in England with high or low rates of breast milk feeding at discharge. Interviews were analysed using the COM-B framework to consider how mothers' behaviour (breast milk feeding and breastfeeding) is affected by capability, opportunity and motivation.

Results: Mothers' motivation in the traumatic situation of very preterm birth was strongly affected by information from staff about the benefits of breast milk for their baby, the importance of early and frequent expressing, and how to assess the effectiveness of direct breastfeeding. It was maintained through positive feedback about their efforts which built their confidence, and reassurance about what is 'normal' growth when a baby begins direct breastfeeding. Motivation needed to be supported by opportunity, including access to equipment for expressing and facilities to stay near the neonatal unit, and also by capability, which required proactive and skilled information and support from staff. Specialist support and facilities varied between units, and some mothers were not given necessary information or had their motivation undermined by staff comments.

Conclusions: Interventions to increase breast milk feeding and breastfeeding for very preterm babies should address mothers' motivation, capability and opportunity, aiming for systematic elimination of obstacles. Mothers value personalised and skilled specialist support, but also need other staff to be able to give consistent information and affirmation focused on their efforts rather than their success, with a trauma-informed approach. Investing in rooming-in facilities that minimise the separation of mothers and babies is likely to overcome a key obstacle.

背景:对于早产儿的母亲来说,在婴儿能够从母乳喂养之前的数周内通过挤奶产生足够的母乳,然后从管式喂养过渡到母乳喂养是一项挑战。如果能在婴儿出生后短时间内刺激泌乳,在 72 小时内建立泌乳,并通过每天挤奶 6-8 次来维持泌乳,则泌乳最成功。本研究探讨了母亲们的经验,即新生儿科的工作人员和设施如何支持早产儿的母乳喂养和母乳喂养:对英国四家出院时母乳喂养率较高或较低的新生儿科的 23 位早产儿母亲进行了访谈。访谈采用 COM-B 框架进行分析,以考虑母亲的行为(母乳喂养和母乳喂养)如何受到能力、机会和动机的影响:结果:在极早产的创伤情况下,工作人员提供的有关母乳对婴儿的益处、早期和频繁挤奶的重要性以及如何评估直接母乳喂养效果的信息对母亲的积极性产生了很大影响。对她们所做努力的积极反馈增强了她们的信心,并再次向她们保证,当婴儿开始直接母乳喂养时,什么是 "正常 "发育。母乳喂养的动机需要得到机会的支持,包括获得挤奶设备和在新生儿病房附近逗留的便利,还需要得到能力的支持,这就需要工作人员提供积极、熟练的信息和支持。不同科室的专业支持和设施各不相同,有些母亲没有得到必要的信息,或者她们的积极性因工作人员的评论而受到影响:增加早产儿母乳喂养和母乳喂养的干预措施应针对母亲的动机、能力和机会,目的是系统性地消除障碍。母亲们重视个性化和专业技能的专家支持,但也需要其他工作人员能够提供一致的信息和肯定,重点关注她们的努力而非成功,并采用创伤知情的方法。投资建设母婴同室设施,尽量减少母婴分离,很可能会克服一个关键障碍。
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引用次数: 0
Prenatal diagnosis, ultrasound findings and pregnancy outcome of 7q11.23 deletion and duplication syndromes: what are the fetal features? 7q11.23 缺失和重复综合征的产前诊断、超声检查结果和妊娠结局:胎儿有哪些特征?
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-06 DOI: 10.1186/s12884-024-06920-2
Xiaojin Luo, Hongyan Niu, Fei Zhou, Xiaohang Chen, Yuanyuan Pei, Weiqiang Liu, Fengxiang Wei

Objective: Analyze the ultrasound findings, single nucleotide polymorphism array (SNP-array) results, and pregnancy outcomes of fetuses with 7q11.23 deletions and duplications in the second and third trimesters. Investigate the prenatal ultrasound characteristics and follow up information of these fetuses.

Methods: Seven fetuses were diagnosed with 7q11.23 deletion and six with 7q11.23 duplication via SNP-array at the prenatal diagnosis center of a single Chinese tertiary medical center from January 2017 to May 2024. Maternal demographics, ultrasound findings, SNP-array results, pregnancy outcomes, and follow-up information were comprehensively reviewed and analyzed.

Results: The copy number variations (CNVs) ranged from 1.43 Mb to 1.78 Mb in cases of 7q11.23 deletions and from 1.42 Mb to 1.68 Mb in cases of 7q11.23 duplications. These CNVs encompassed 29 OMIM-listed genes, including ELN, DNAJC30, GTF2IRD1, and GTF2I. Among the seven cases of 7q11.23 deletion syndrome, six exhibited ultrasound abnormalities. The main clinical phenotypes included three cases of intrauterine growth restriction and four cases of cardiovascular system abnormalities, specifically two cases with ventricular septal defects, one case with aortic narrowing, and one case with supravalvular pulmonary stenosis. One case was particularly notable, exhibiting complex multi-organ structural malformations. Out of six cases of 7q11.23 duplication syndrome, five exhibited ultrasound abnormalities. These included two cases of cardiovascular abnormalities: one case with a widened left ventricle and another case with a shortened fetal humerus length. One case revealed complex multi-organ structural malformations, including hydronephrosis, a microgallbladder, and a cleft lip and palate. All seven cases of 7q11.23 deletions and three cases of 7q11.23 duplications opted for termination of the pregnancy. The remaining three cases of 7q11.23 duplications chose to continue the pregnancy. One case underwent surgical treatment for a ventricular septal defect after birth, and the prognosis was favorable. Another case involved a full-term delivery, this child was followed up at the age of 4 and exhibited a phenotype of poor language expression ability.

Conclusion: Our study broadened the clinical phenotype spectrum of fetuses with 7q11.23 deletions and duplications. Additionally, it conducted a preliminary evaluation of prenatal ultrasound findings and postnatal clinical phenotypes in follow-up cases. The clinical phenotype of fetuses with 7q11.23 deletion and duplication syndromes involves multiple systems and is relatively complex. Cardiovascular abnormalities and intrauterine growth restriction are the most common clinical manifestations observed in prenatal 7q11.23 deletion syndrome. Fetuses with 7q11.23 duplications exhibit a wide range of clinical phenotypes that lack specificity.

目的分析7q11.23缺失和重复胎儿在第二和第三孕期的超声检查结果、单核苷酸多态性阵列(SNP-array)结果和妊娠结局。调查这些胎儿的产前超声特征和随访信息:2017年1月至2024年5月,在中国一家三级医疗中心的产前诊断中心,通过SNP-array诊断出7个7q11.23缺失的胎儿和6个7q11.23重复的胎儿。对产妇的人口统计学资料、超声检查结果、SNP-阵列结果、妊娠结局和随访信息进行了全面回顾和分析:7q11.23缺失病例的拷贝数变异(CNVs)范围为1.43 Mb至1.78 Mb,7q11.23重复病例的拷贝数变异范围为1.42 Mb至1.68 Mb。这些 CNV 包含 29 个 OMIM 列出的基因,包括 ELN、DNAJC30、GTF2IRD1 和 GTF2I。在7例7q11.23缺失综合征病例中,有6例表现出超声波异常。主要临床表型包括三例宫内生长受限和四例心血管系统异常,其中两例为室间隔缺损,一例为主动脉缩窄,一例为瓣上肺动脉狭窄。其中一例尤为突出,表现出复杂的多器官结构畸形。在 6 例 7q11.23 重复综合征病例中,有 5 例表现出超声波异常。其中包括两例心血管畸形:一例左心室增宽,另一例胎儿肱骨长度缩短。一个病例显示复杂的多器官结构畸形,包括肾积水、小膀胱和唇腭裂。所有 7 例 7q11.23 缺失病例和 3 例 7q11.23 重复病例都选择了终止妊娠。其余 3 例 7q11.23 缺失病例选择继续妊娠。其中一例在出生后接受了室间隔缺损的手术治疗,预后良好。另一个病例为足月产,该患儿在 4 岁时接受了随访,表现出语言表达能力差的表型:我们的研究扩大了 7q11.23 缺失和重复胎儿的临床表型范围。结论:我们的研究拓宽了 7q11.23 缺失和重复胎儿的临床表型谱系,并对随访病例的产前超声检查结果和产后临床表型进行了初步评估。7q11.23 缺失和重复综合征胎儿的临床表型涉及多个系统,相对复杂。心血管异常和宫内生长受限是产前 7q11.23 缺失综合征最常见的临床表现。7q11.23重复的胎儿表现出多种临床表型,缺乏特异性。
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引用次数: 0
Providers' perspective on vaginal birth after cesarean birth: a qualitative systematic review. 提供者对剖宫产后阴道分娩的看法:定性系统综述。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-06 DOI: 10.1186/s12884-024-06921-1
Antita Kanjanakaew, Atchareya Jiramanee, Manassawee Srimoragot

Background: Vaginal Birth after Cesarean Birth (VBAC) is a birth mode recommended for reducing repeat cesarean which potentially contributes to adverse outcomes. However, VBAC is not normally practiced in some countries. Providers are an important part of the decision-making process on modes of birth among pregnant individuals. Providers' perspective on VBAC can influence whether they support or avoid conducting VBAC. This review aimed to explore providers' perspective on VBAC.

Methods: The comprehensive search was conducted from six databases including PubMed, MEDLINE, Scopus, Cochrane Library, EMBASE, and Google scholar. The studies published in English between 2013 and 2023 were review. The Medical Subject Heading terms for VBAC and perspective were used to search. The eligible studies were selected by the PRISMA flow chart. The initial search yielded 558 articles. After excluding duplicates, articles not retrieved for full-text, and not meeting inclusion and exclusion criteria, eight articles were recruited. Quality appraisal of the studies was performed by the tool of the Joanna Briggs Institute. The meta-aggregation approach was applied to synthesize the findings.

Results: Eight qualitative articles were included in this review, and six themes were developed including (1) different recognition of VBAC, (2) differences of willingness level of conducting Trial of Labor after Cesarean (TOLAC) (the approach attempting to have VBAC), (3) skills and resources needed when performing TOLAC, (4) protocol for recruiting candidacy and TOLAC management, (5) final decision making on VBAC, and (6) onset and duration of providing TOLAC information.

Conclusion: Providers play an important role in influencing individuals' decision on modes of birth. Providers' positive recognition and willingness of conducting TOLAC potentially impact successful VBAC rate. However, the lawsuit caused by adverse outcomes from TOLAC/VBAC is a main reason for choosing repeat cesarean.

Trial registration: PROSPERO registration number of this systematic review: CRD42023427662.

背景:剖腹产后阴道分娩(VBAC)是一种推荐的分娩方式,可减少可能导致不良后果的重复剖腹产。然而,在一些国家,VBAC 并不普遍。医疗服务提供者是孕妇分娩方式决策过程的重要组成部分。医护人员对 VBAC 的看法会影响他们是否支持或避免进行 VBAC。本综述旨在探讨医护人员对 VBAC 的看法:方法:从 PubMed、MEDLINE、Scopus、Cochrane Library、EMBASE 和 Google scholar 等六个数据库中进行全面检索。对 2013 年至 2023 年间发表的英文研究进行了审查。检索时使用了医学主题词 "VBAC "和 "视角"。根据 PRISMA 流程图筛选出符合条件的研究。初步检索结果为 558 篇文章。在剔除重复文章、未检索到全文的文章以及不符合纳入和排除标准的文章后,共征集到 8 篇文章。研究质量评估采用乔安娜-布里格斯研究所(Joanna Briggs Institute)的工具进行。采用元汇总法对研究结果进行综合:本综述纳入了 8 篇定性文章,并形成了 6 个主题,包括:(1)对 VBAC 的不同认识;(2)进行剖宫产术后试产(TOLAC)(尝试进行 VBAC 的方法)的意愿水平差异;(3)进行 TOLAC 时所需的技能和资源;(4)招募候选者和 TOLAC 管理协议;(5)VBAC 的最终决策;以及(6)提供 TOLAC 信息的开始时间和持续时间:医疗服务提供者在影响个人决定分娩方式方面发挥着重要作用。医疗服务提供者对 TOLAC 的积极认可和意愿可能会影响 VBAC 的成功率。然而,TOLAC/VBAC 的不良结果引起的诉讼是选择再次剖腹产的主要原因:本系统综述的 PROSPERO 注册号:CRD42023427662。
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引用次数: 0
Postnatal care after gestational diabetes - a systematic review of clinical practice guidelines. 妊娠糖尿病产后护理--临床实践指南系统回顾。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-04 DOI: 10.1186/s12884-024-06899-w
Phyllis Ohene-Agyei, Ariba Iqbal, Jane E Harding, Caroline A Crowther, Luling Lin

Background: Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy and later is associated with an increased risk of type 2 diabetes and other metabolic disorders. Consistent and evidence based postnatal care is key to improving maternal long-term health. We therefore aimed to review and compare recommendations of national and international clinical practice guidelines (CPG) for postnatal care after GDM and identify any evidence gaps in recommendations needing further research.

Methods: We searched five databases and forty professional organization websites for CPGs providing recommendations for postnatal care after GDM. CPGs which had full versions in English, endorsed, prepared, or authorized by a professional body, and published between 2013 and 2023 were eligible for inclusion. Two reviewers independently screened the articles, extracted the recommendations, and appraised the included CPGs using the Appraisal of Guidelines, Research, and Evaluation (AGREE) II tool.

Results: Twenty-six CPGs from 22 countries were included. Twelve CPGs (46%) were appraised as low quality with the lowest scoring domains being rigor of development and editorial independence. We found little high certainty evidence for most recommendations and few recommendations were made for maternal mental health and postpartum metabolic screening. Evidence gaps pertained to postpartum glucose screening, including frequency, tests, and ways to improve uptake, evaluation of effective uptake of lifestyle interventions, and ongoing long-term follow up care.

Conclusions: Most of the postnatal care recommendations in GDM guidelines are not based on high certainty evidence. Further efforts are needed to improve the global evidence base for postnatal care after GDM to improve long-term maternal health.

Protocol registration: This review was registered in PROSEPRO (CRD42023454900).

背景:妊娠期糖尿病(GDM)是妊娠期最常见的代谢紊乱疾病,其后罹患 2 型糖尿病和其他代谢紊乱的风险增加。以证据为基础的一致产后护理是改善产妇长期健康的关键。因此,我们旨在回顾和比较国家和国际临床实践指南(CPG)中有关 GDM 产后护理的建议,并找出建议中需要进一步研究的证据差距:我们在五个数据库和四十个专业组织的网站上搜索了为 GDM 产后护理提供建议的 CPG。2013年至2023年期间出版的、由专业机构认可、编写或授权的完整英文版CPG均符合纳入条件。两名审稿人独立筛选文章、提取建议,并使用指南、研究和评价评估(AGREE)II工具对纳入的CPG进行评估:结果:共纳入了来自 22 个国家的 26 份国家方案指南。其中 12 份 CPG(46%)被评为低质量,得分最低的领域是制定的严谨性和编辑的独立性。我们发现大多数建议几乎没有高确定性的证据,对孕产妇心理健康和产后代谢筛查的建议也很少。产后血糖筛查方面存在证据缺口,包括频率、测试和提高接受率的方法、生活方式干预有效接受率的评估以及持续的长期随访护理:结论:GDM 指南中的大多数产后护理建议并非基于高度确定的证据。需要进一步努力完善全球 GDM 产后护理的证据基础,以改善孕产妇的长期健康状况:本综述已在 PROSEPRO 注册(CRD42023454900)。
{"title":"Postnatal care after gestational diabetes - a systematic review of clinical practice guidelines.","authors":"Phyllis Ohene-Agyei, Ariba Iqbal, Jane E Harding, Caroline A Crowther, Luling Lin","doi":"10.1186/s12884-024-06899-w","DOIUrl":"10.1186/s12884-024-06899-w","url":null,"abstract":"<p><strong>Background: </strong>Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy and later is associated with an increased risk of type 2 diabetes and other metabolic disorders. Consistent and evidence based postnatal care is key to improving maternal long-term health. We therefore aimed to review and compare recommendations of national and international clinical practice guidelines (CPG) for postnatal care after GDM and identify any evidence gaps in recommendations needing further research.</p><p><strong>Methods: </strong>We searched five databases and forty professional organization websites for CPGs providing recommendations for postnatal care after GDM. CPGs which had full versions in English, endorsed, prepared, or authorized by a professional body, and published between 2013 and 2023 were eligible for inclusion. Two reviewers independently screened the articles, extracted the recommendations, and appraised the included CPGs using the Appraisal of Guidelines, Research, and Evaluation (AGREE) II tool.</p><p><strong>Results: </strong>Twenty-six CPGs from 22 countries were included. Twelve CPGs (46%) were appraised as low quality with the lowest scoring domains being rigor of development and editorial independence. We found little high certainty evidence for most recommendations and few recommendations were made for maternal mental health and postpartum metabolic screening. Evidence gaps pertained to postpartum glucose screening, including frequency, tests, and ways to improve uptake, evaluation of effective uptake of lifestyle interventions, and ongoing long-term follow up care.</p><p><strong>Conclusions: </strong>Most of the postnatal care recommendations in GDM guidelines are not based on high certainty evidence. Further efforts are needed to improve the global evidence base for postnatal care after GDM to improve long-term maternal health.</p><p><strong>Protocol registration: </strong>This review was registered in PROSEPRO (CRD42023454900).</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"720"},"PeriodicalIF":2.8,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Development and validation of an ultrasound-based estimated fetal weight reference for Chinese twin pregnancy: a retrospective cohort study. 中国双胎妊娠超声估测胎儿体重参考值的开发与验证:一项回顾性队列研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-04 DOI: 10.1186/s12884-024-06924-y
Jing Yang, Hongzhao Yu, Yangyu Zhao, Zhihao Cheng, Yufeng Du, Pengbo Yuan, Aiqing Zhang, Yang Liu, Xiaoli Gong, Yang Yu, Yixin Li, Xiaoyan You, Nana Huang, Youzhen Zhang, Xiya Sun, Hongbo Qi, Hong-Tian Li, Yuan Wei

Background: Fetal growth monitoring is important for twin pregnancies. However, there has been no clinically validated tool for monitoring fetal growth of twin pregnancies in China. This study aims to develop and validate a chorionicity-specific growth chart of ultrasound estimated fetal weight (EFW) for Chinese twin pregnancies.

Methods: This retrospective cohort study included all twin pregnancies who delivered two live fetuses with gestational age ≥ 34 weeks without severe obstetric complications at a tertiary hospital from January 2007 to March 2021. The participants were divided into a development set (delivered in or before December 2017) and a validation set (delivered in or after January 2018). Chorionicity-specific growth charts were created using the generalized additive models for location, scale, and shape (GAMLSS) based on the development set. The fetuses from the validation set were classified into three groups based on the last EFW: small-for-gestational-age (SGA) indicated by both the newly established twin charts and the Hadlock singleton chart currently used for twin pregnancies in China, suspected SGA indicated by only the singleton chart, and no SGA indicated by either chart. The incidence of neonatal outcomes among the three groups was then compared accordingly, including intensive care unit (NICU) stay length, respiratory diseases, and neurological disorders.

Results: The development set included 883 twin pregnancies and a total of 6374 EFW measurements between 16 and 38 weeks of gestation, and the validation set included 801 twin pregnancies and 7630 EFW measurements. In the development set, monochorionic diamniotic (MCDA) twins had a significantly lower EFW compared to dichorionic diamniotic (DCDA) twins beginning at 26 weeks, with the difference gradually increasing thereafter, supporting the establishment of chorionicity-specific growth charts. Of the 1,602 twin neonates in the validation set, 103 (6.4%) were classified into the SGA group, 164 (10.2%) into the suspected SGA group, and 1335 (83.3%) into the no SGA group. The incidence of respiratory diseases and neurological disorders was comparable between the suspected SGA group and the no SGA group, but apparently higher in the SGA group. Meanwhile, NICU stay lengths were consistently longer for twins in the SGA group compared to the no SGA group (difference: 0.57, 95% CI: 0.31-0.83), with no significant differences observed between the suspected SGA and no SGA groups.

Conclusions: The fetal growth trajectories differed by chorionicity, with a lower EFW for MCDA twins beginning at 26 weeks. The establishment of chorionicity-specific growth chart could reduce overdiagnosis of SGA and improve fetal growth monitoring of twin pregnancies.

背景:胎儿生长监测对双胎妊娠非常重要。然而,在中国还没有经过临床验证的监测双胎妊娠胎儿生长的工具。本研究旨在为中国双胎妊娠开发并验证绒毛膜特异性超声估测胎儿体重(EFW)生长图表:这项回顾性队列研究纳入了 2007 年 1 月至 2021 年 3 月在一家三级医院分娩的所有双胎妊娠,这些妊娠均有两个胎龄≥34 周的活胎,且无严重产科并发症。参与者分为开发组(2017 年 12 月或之前分娩)和验证组(2018 年 1 月或之后分娩)。在发育集的基础上,使用位置、比例和形状的广义加性模型(GAMLSS)创建了绒毛膜特异性生长图。根据最后一次EFW将验证集中的胎儿分为三组:新建立的双胎图和目前在中国用于双胎妊娠的Hadlock单胎图均显示为小于妊娠年龄(SGA)的胎儿;仅单胎图显示为疑似SGA的胎儿;两种图均未显示为SGA的胎儿。然后比较三组新生儿的预后,包括重症监护室(NICU)住院时间、呼吸系统疾病和神经系统疾病:开发集包括 883 例双胎妊娠,在妊娠 16 至 38 周期间共测量了 6374 例 EFW;验证集包括 801 例双胎妊娠,测量了 7630 例 EFW。在发育集中,单绒毛膜双胎(MCDA)与二绒毛膜双胎(DCDA)相比,从26周开始,EFW明显较低,之后差异逐渐增大,这支持了绒毛膜特异性生长图表的建立。在验证集的 1602 个双胞胎新生儿中,103 个(6.4%)被归入 SGA 组,164 个(10.2%)被归入疑似 SGA 组,1335 个(83.3%)被归入无 SGA 组。呼吸系统疾病和神经系统疾病的发病率在疑似 SGA 组和非 SGA 组之间不相上下,但 SGA 组的发病率明显较高。同时,与无SGA组相比,SGA组双胞胎的新生儿重症监护室住院时间持续较长(差异:0.57,95% CI:0.31-0.83),而疑似SGA组与无SGA组之间无显著差异:结论:胎儿的生长轨迹因绒毛膜性而异,MCDA 双胎的 EFW 从 26 周开始较低。建立绒毛膜特异性生长曲线图可减少SGA的过度诊断,并改善双胎妊娠的胎儿生长监测。
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引用次数: 0
The effect of hereditary thrombophilia on recurrent pregnancy loss: a retrospective cohort study. 遗传性血栓性疾病对复发性妊娠失败的影响:一项回顾性队列研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-04 DOI: 10.1186/s12884-024-06926-w
Hasan Berkan Sayal, Mehmet Sinan Beksac

Objective: Thrombophilia screening has been performed in patients with conditions such as previous fetal death, (fetal growth restriction) FGR, preeclampsia, (hemolysis. elevated liver enzyme, low platelet count) HELLP Syndrome, previous abruptio placentae, previous thrombosis in pregnancy, and abnormal placental histology. The actual role of hereditary thrombophilia in recurrent pregnancy loss (RPL) is still debated. This study was intended to determine the incidence of specific gene defects for hereditary thrombophilia and to ascertain their impact on RPL in central Anatolia in Turkey.

Methods: This retrospective cohort study was performed between January 2012 and December 2022. All pregnant women with a complete hereditary screening profile were included. The investigated gene polymorphisms were methylenetetrahydrofolate reductase (MTHFR) C677T, MTHFR A1298C, Factor V Leiden G1691A, and Factor II prothrombin G20210A. Cases of pregnant women at least two or more consecutive pregnancy losses before 22 weeks of gestation were defined as RPL. The rates of genetic screening and their association with RPL were analyzed.

Results: RPL was identified in 224 (27.58%) of the 812 pregnant women with complete genetic screening. Although there was no difference in terms of age, body mass index, numbers of ectopic pregnancies, molar pregnancies, or dilatation & curettage (p > 0.05), gravity (2.0 [2.0-3.0] vs. 4.0 [3.0-5.0]), parity (1.0 [1.0-2.0] vs. 1.0 [0-1.0]), live birth (1.0 [1.0-2.0] vs. 1.0 [0-1.0]), anembryonic pregnancy (0 [0-0] vs. 0 [0-0]), miscarriage (0 [0-1.0] vs. 3.0 [2.0-3.0]), and stillbirth (0 [0-0] vs. 0 [0-0]) numbers differed significantly between the groups (p < 0.05). While no significant differences were determined in MTHFR A1298C, Factor V Leiden, factor II prothrombin G20210A, or homocysteine levels (p > 0.05), the homozygous MTHFR C677T positivity rates differed significantly (6.3% in the non-RPL group vs. 11.6% in the RPL group, p = 0.027) .

Conclusion: The homozygous MTHFR C677T polymorphisms was found to be more frequent in women with RPL. Further studies with larger cohorts are needed to confirm our results.

目的:血栓性疾病筛查适用于曾有胎儿死亡、(胎儿生长受限)FGR、子痫前期、(溶血、肝酶升高、血小板计数低)HELLP 综合征、曾有胎盘早剥、曾有妊娠期血栓形成以及胎盘组织学异常等情况的患者。遗传性血栓性疾病在复发性妊娠失败(RPL)中的实际作用仍存在争议。本研究旨在确定遗传性血栓性疾病特定基因缺陷的发生率,并确定其对土耳其安纳托利亚中部地区复发性妊娠失败的影响:这项回顾性队列研究在 2012 年 1 月至 2022 年 12 月期间进行。方法:这项回顾性队列研究在 2012 年 1 月至 2022 年 12 月期间进行,纳入了所有具有完整遗传筛查资料的孕妇。研究的基因多态性包括亚甲基四氢叶酸还原酶(MTHFR)C677T、MTHFR A1298C、因子 V Leiden G1691A 和因子 II 凝血酶原 G20210A。妊娠 22 周前至少连续两次或两次以上妊娠失败的孕妇被定义为 RPL。对基因筛查率及其与 RPL 的关系进行了分析:结果:在进行了完整基因筛查的 812 名孕妇中,有 224 人(27.58%)被确定为 RPL。虽然在年龄、体重指数、异位妊娠次数、磨牙妊娠次数、扩张和刮宫次数(P > 0.05)、重力(2.0 [2.0-3.0] vs. 4.0 [3.0-5.0])、奇偶数(1.0 [1.0-2.0] vs. 1.0 [0-1.0])、活产(1.0 [1.0-2.0] vs. 1.0 [0-1.0])、无胚胎妊娠(0 [0-0] vs. 0 [0-0])、流产(0 [0-0] vs. 0.0 [0-0])等方面没有差异。组间的同型 MTHFR C677T 阳性率差异显著(非RPL 组为 6.3%,RPL 组为 11.6%,P = 0.027):同型 MTHFR C677T 多态性在患有 RPL 的妇女中更为常见。要证实我们的研究结果,还需要进行更大规模的队列研究。
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引用次数: 0
Comparison of two different suction curettage methods in cesarean scar pregnancy treatment. 比较两种不同的抽吸刮宫法在剖宫产瘢痕妊娠治疗中的应用。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-31 DOI: 10.1186/s12884-024-06917-x
Burak Elmas, Neslihan Ozturk, Emine Kizil, Bergen Laleli Koc, Ugurcan Zorlu, Duygu Tugrul Ersak, Turkan Dikici Aktas, Asuman Erten, Salim Erkaya

Background: Cesarean scar pregnancy (CSP), the incidence of which is increasing, can lead to life-threatening consequences. In this study, it was aimed to compare the results of two different ultrasound-assisted suction curettage (SC) approaches that we applied to endogenous type CSPs in different time periods.

Methods: Patients who were diagnosed with CSP and treated with SC in the early pregnancy service between January 2012 and March 2019 were included in the study. While classical SC was applied until December 2016, patients were treated with SC modified by us after this date. Demographic characteristics, preoperative clinical findings, intraoperative characteristics and postoperative short-term follow-up of these two groups of patients belonging to different time periods were compared.

Results: 34 patients were treated with classic SC (Group 1) and 32 patients with modified SC (Group 2). The amount of decrease in Hemoglobin values measured at the sixth hour postoperatively compared to the preoperative period was found to be less in group 2 (1.01 ± 0.67 g/dl) than in group 1 (1.39 ± 0.85 g/dl) (p = 0.042). The treatment failure rate was found to be lower in group 2 (p = 0.028). According to the results of multiple logistic regression analysis of significant factors associated with treatment outcome, myometrial thickness measurement and the largest gestational diameter measurement were found to be significant independent factors.

Conclusion: In CSP cases, SC procedure with abdominal ultrasonography is an effective and reliable approach. At the beginning of this surgical procedure, if the gestational sac is removed from the uterine wall with the curettage cannula before suction, the success of the procedure will increase even more.

背景:剖宫产瘢痕妊娠(CSP)的发病率越来越高,可导致危及生命的后果。本研究旨在比较我们在不同时期对内源性疤痕妊娠采用的两种不同超声辅助吸刮术(SC)的效果:研究纳入了2012年1月至2019年3月期间在早孕服务中被诊断为CSP并接受SC治疗的患者。在 2016 年 12 月之前使用的是经典的 SC,而在 2016 年 12 月之后,患者接受了由我们改良的 SC 治疗。研究比较了不同时期两组患者的人口统计学特征、术前临床结果、术中特征和术后短期随访情况:结果:34 名患者接受了传统 SC 治疗(第 1 组),32 名患者接受了改良 SC 治疗(第 2 组)。术后第六小时测量的血红蛋白值与术前相比,第二组(1.01 ± 0.67 g/dl)的下降幅度低于第一组(1.39 ± 0.85 g/dl)(p = 0.042)。第 2 组的治疗失败率较低(p = 0.028)。根据与治疗结果相关的重要因素的多元逻辑回归分析结果,发现子宫肌层厚度测量和最大妊娠直径测量是重要的独立因素:结论:在CSP病例中,使用腹部超声波进行SC手术是一种有效而可靠的方法。在手术开始时,如果在吸宫前用刮宫套管将妊娠囊从子宫壁上取出,手术的成功率将进一步提高。
{"title":"Comparison of two different suction curettage methods in cesarean scar pregnancy treatment.","authors":"Burak Elmas, Neslihan Ozturk, Emine Kizil, Bergen Laleli Koc, Ugurcan Zorlu, Duygu Tugrul Ersak, Turkan Dikici Aktas, Asuman Erten, Salim Erkaya","doi":"10.1186/s12884-024-06917-x","DOIUrl":"10.1186/s12884-024-06917-x","url":null,"abstract":"<p><strong>Background: </strong>Cesarean scar pregnancy (CSP), the incidence of which is increasing, can lead to life-threatening consequences. In this study, it was aimed to compare the results of two different ultrasound-assisted suction curettage (SC) approaches that we applied to endogenous type CSPs in different time periods.</p><p><strong>Methods: </strong>Patients who were diagnosed with CSP and treated with SC in the early pregnancy service between January 2012 and March 2019 were included in the study. While classical SC was applied until December 2016, patients were treated with SC modified by us after this date. Demographic characteristics, preoperative clinical findings, intraoperative characteristics and postoperative short-term follow-up of these two groups of patients belonging to different time periods were compared.</p><p><strong>Results: </strong>34 patients were treated with classic SC (Group 1) and 32 patients with modified SC (Group 2). The amount of decrease in Hemoglobin values measured at the sixth hour postoperatively compared to the preoperative period was found to be less in group 2 (1.01 ± 0.67 g/dl) than in group 1 (1.39 ± 0.85 g/dl) (p = 0.042). The treatment failure rate was found to be lower in group 2 (p = 0.028). According to the results of multiple logistic regression analysis of significant factors associated with treatment outcome, myometrial thickness measurement and the largest gestational diameter measurement were found to be significant independent factors.</p><p><strong>Conclusion: </strong>In CSP cases, SC procedure with abdominal ultrasonography is an effective and reliable approach. At the beginning of this surgical procedure, if the gestational sac is removed from the uterine wall with the curettage cannula before suction, the success of the procedure will increase even more.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"717"},"PeriodicalIF":2.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Uganda: a prospective cohort study. 乌干达一家三级医院产科急诊转诊产妇中新生儿即刻不良预后的发生率和相关因素:一项前瞻性队列研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-30 DOI: 10.1186/s12884-024-06900-6
Geoffrey Okot, Samuel Omara, Musa Kasujja, Francis Pebolo Pebalo, Petrus Baruti, Naranjo Almenares Ubarnel

Background: High rates of adverse neonatal outcomes in resource-limited settings are multifactorial, varying by country, region, and institution. In sub-Saharan Africa, the majority of adverse neonatal outcomes are intrapartum related, and studies in Uganda have shown that referral in labor is a major determinant of adverse neonatal outcomes. This study aimed to assess the incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Eastern Uganda.

Materials and methods: This was a prospective cohort study involving 265 women who were referred in labor to Jinja Regional Referral Hospital in Uganda with emergency obstetric complications. The exposure of interest was being referred with obstetrical emergency, and the outcome variable was adverse neonatal outcomes. The study was conducted between July 5, 2023, and October 5, 2023. Consecutive sampling was used, and data on sociodemographic and obstetric factors, referral related factors, as well as the primary outcome variable (adverse neonatal outcome) were collected via interviewer-administered questionnaires. The data were then cleaned, coded, and analyzed using STATA version 14. Log-binomial regression determined risk ratios and associations for factors related to adverse neonatal outcomes. Variables with p-values < 0.2 in bivariable analysis were included in the multivariable analysis, where significance was set at p < 0.05.

Results: Of the 265 women exposed to emergency obstetrical referrals, 40% experienced adverse neonatal outcomes, a composite measure including neonatal intensive care admission (27.6%), low Apgar score (23.8%), fresh stillbirth (11.3%), early-onset neonatal infection (6.8%), and early neonatal death (2.3%). Factors significantly associated with adverse neonatal outcomes were; maternal age ≥ 35 years (aRR = 1.72, CI:1.194-2.477, p value = 0.004), APH (aRR = 2.48, CI: 1.859-3.311, p-value < 0.001), and non-reassuring fetal status (aRR = 1.90, CI: 1.394-2.584, p-value < 0.001).

Conclusions: The study found a high rate of adverse neonatal outcomes among emergency obstetric referrals, with 40% of participants facing issues like ICU admissions, low Apgar scores and fresh stillbirth. Key factors included maternal age over 35, antepartum hemorrhage, and non-reassuring fetal status. These results highlight the urgent need for targeted interventions in emergency obstetric care. Strategies should enhance referral systems, improve facility preparedness, train healthcare providers, and educate communities on timely referrals and managing high-risk pregnancies.

背景:在资源有限的环境中,新生儿不良结局的高发生率是多因素的,因国家、地区和机构而异。在撒哈拉以南非洲地区,大多数不良新生儿预后都与产期有关,乌干达的研究表明,产期转诊是不良新生儿预后的主要决定因素。本研究旨在评估乌干达东部一家三级医院产科急诊转诊产妇中新生儿不良预后的发生率和相关因素:这是一项前瞻性队列研究,涉及265名因产科急诊并发症转诊至乌干达金贾地区转诊医院的产妇。研究对象为因产科急症转诊的产妇,研究结果为新生儿不良结局。研究在 2023 年 7 月 5 日至 2023 年 10 月 5 日期间进行。研究采用连续抽样法,通过访谈者发放的调查问卷收集社会人口学和产科因素、转诊相关因素以及主要结果变量(新生儿不良结局)的数据。然后使用 STATA 14 版本对数据进行清理、编码和分析。对数二项式回归确定了新生儿不良结局相关因素的风险比和关联。变量与 p 值 结果:在接受产科急诊转诊的 265 名产妇中,有 40% 出现了新生儿不良结局,这是一项综合指标,包括新生儿重症监护入院(27.6%)、低 Apgar 评分(23.8%)、新鲜死胎(11.3%)、早发新生儿感染(6.8%)和早发新生儿死亡(2.3%)。与新生儿不良结局明显相关的因素有:产妇年龄≥35 岁(aRR = 1.72,CI:1.194-2.477,P 值 = 0.004)、APH(aRR = 2.48,CI:1.859-3.311,P 值 结论:研究发现,产科急诊转诊中新生儿不良结局的发生率很高,40%的参与者面临重症监护室入院、Apgar 评分低和死胎等问题。关键因素包括产妇年龄超过 35 岁、产前大出血和胎儿状态不稳定。这些结果突出表明,急诊产科护理迫切需要有针对性的干预措施。相关策略应加强转诊系统、改善医疗机构的准备情况、培训医疗服务提供者,并对社区进行及时转诊和管理高危妊娠的教育。
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引用次数: 0
Proteomic analysis of plasma total exosomes and placenta-derived exosomes in patients with gestational diabetes mellitus in the first and second trimesters. 妊娠期前三个月和后三个月妊娠糖尿病患者血浆总外泌体和胎盘衍生外泌体的蛋白质组学分析。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-30 DOI: 10.1186/s12884-024-06919-9
Jing Lin, Danqing Zhao, Yi Liang, Zhiyuan Liang, Mingxian Wang, Xiaoxiao Tang, Hongbin Zhuang, Hanghang Wang, Xiaoping Yin, Yuhan Huang, Li Yin, Liming Shen

Gestational diabetes mellitus (GDM) is the first spontaneous hyperglycemia during pregnancy. Early diagnosis and intervention are important for the management of the disease. This study compared and analyzed the proteins of total plasma exosomes (T-EXO) and placental-derived exosomes (PLAP-EXO) in pregnant women who subsequently developed GDM (12-16 weeks), GDM patients (24-28 weeks) and their corresponding controls to investigate the pathogenesis and biomarkers of GDM associated with exosomes. The exosomal proteins were extracted and studied by proteomics approach, then bioinformatics analysis was applied to the differentially expressed proteins (DEPs) between the groups. At 12-16 and 24-28 weeks of gestation, 36 and 21 DEPs were identified in T-EXO, while 34 and 20 DEPs were identified in PLAP-EXO between GDM and controls, respectively. These proteins are mainly involved in complement pathways, immunity, inflammation, coagulation and other pathways, most of them have been previously reported as blood or exosomal proteins associated with GDM. The findings suggest that the development of GDM is a progressive process and that early changes promote the development of the disease. Maternal and placental factors play a key role in the pathogenesis of GDM. These proteins especially Hub proteins have the potential to become predictive and diagnostic biomarkers for GDM.

妊娠糖尿病(GDM)是妊娠期间首次出现的自发性高血糖。早期诊断和干预对疾病的治疗非常重要。本研究比较分析了妊娠12-16周的GDM孕妇、妊娠24-28周的GDM患者及其对照组的总血浆外泌体(T-EXO)和胎盘洐生外泌体(PLAP-EXO)的蛋白质,以研究与外泌体相关的GDM发病机制和生物标志物。通过蛋白质组学方法提取并研究了外泌体蛋白,然后应用生物信息学分析了各组间的差异表达蛋白(DEPs)。在妊娠12-16周和24-28周时,在T-EXO中分别发现了36个和21个差异表达蛋白,而在PLAP-EXO中分别发现了34个和20个差异表达蛋白。这些蛋白质主要参与补体途径、免疫、炎症、凝血和其他途径,其中大多数以前曾被报道为与GDM相关的血液或外泌体蛋白质。研究结果表明,GDM 的发展是一个渐进的过程,早期的变化会促进疾病的发展。母体和胎盘因素在 GDM 的发病机制中起着关键作用。这些蛋白质尤其是 Hub 蛋白有可能成为预测和诊断 GDM 的生物标志物。
{"title":"Proteomic analysis of plasma total exosomes and placenta-derived exosomes in patients with gestational diabetes mellitus in the first and second trimesters.","authors":"Jing Lin, Danqing Zhao, Yi Liang, Zhiyuan Liang, Mingxian Wang, Xiaoxiao Tang, Hongbin Zhuang, Hanghang Wang, Xiaoping Yin, Yuhan Huang, Li Yin, Liming Shen","doi":"10.1186/s12884-024-06919-9","DOIUrl":"10.1186/s12884-024-06919-9","url":null,"abstract":"<p><p>Gestational diabetes mellitus (GDM) is the first spontaneous hyperglycemia during pregnancy. Early diagnosis and intervention are important for the management of the disease. This study compared and analyzed the proteins of total plasma exosomes (T-EXO) and placental-derived exosomes (PLAP-EXO) in pregnant women who subsequently developed GDM (12-16 weeks), GDM patients (24-28 weeks) and their corresponding controls to investigate the pathogenesis and biomarkers of GDM associated with exosomes. The exosomal proteins were extracted and studied by proteomics approach, then bioinformatics analysis was applied to the differentially expressed proteins (DEPs) between the groups. At 12-16 and 24-28 weeks of gestation, 36 and 21 DEPs were identified in T-EXO, while 34 and 20 DEPs were identified in PLAP-EXO between GDM and controls, respectively. These proteins are mainly involved in complement pathways, immunity, inflammation, coagulation and other pathways, most of them have been previously reported as blood or exosomal proteins associated with GDM. The findings suggest that the development of GDM is a progressive process and that early changes promote the development of the disease. Maternal and placental factors play a key role in the pathogenesis of GDM. These proteins especially Hub proteins have the potential to become predictive and diagnostic biomarkers for GDM.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"713"},"PeriodicalIF":2.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Use of uterine electromyography in the prediction of preterm birth after transvaginal cervical cerclage. 使用子宫肌电图预测经阴道宫颈环扎术后的早产情况。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-30 DOI: 10.1186/s12884-024-06779-3
Haitian Xie, Menglan Zhu, Kewen Deng, Jinling Yi, Liqiong Zhu, Jianping Tan, Xiaohui Ji, Phei Er Saw, Chunwei Cao, Nengyong Ouyang, Hui Chen

Background: Preterm birth (PTB), complications of which account for approximately 35% of deaths among neonates, remains a crucial issue. Cervical insufficiency (CI) is defined as the inability of the utrine cervix to retain a pregnancy, leading to PTB. Cervical cerclage is an efficient surgery for CI patients by preventing the cervix from being further mechanically shortened. Unfortunately, a certain number of patients who had cerclage still delivered prematurely, raising the urgent need to accurately assess the risk of PTB in patients with cerclage. Uterine electromyography (uEMG) is an emerging technology that characterizes uterine contractions by describing the actual evolution process of uterine activity and has been used to predict PTB in recent years.

Method: In this single-center retrospective case-control study, singleton pregnancy women who received cervical cerclage and uEMG assessment between January 2018 and January 2022 at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University were enrolled.

Results: 32 PTBs were observed of the 69 women who underwent assessment. Based on multivariate logistic regression analysis, PTB after cerclage was significantly associated with previous PTB history or mid-trimester pregnancy loss (OR: 2.87, 95%CI: 1.49-5.54) and contraction frequency detected by uEMG (OR: 2.24, 95%CI: 1.44-3.49). The AUC of contraction frequency (0.766, P<0.001) was observed, and the optimal cut-off value suggested by Youden Index was 1.75 times per hour. Combined with previous preterm history and cervical length, the AUC of contraction frequency reached 0.858. After stratification by contraction frequency, the median duration was 11 weeks in the high frequency group (> 1.75 times per hour) and 15 weeks in the low frequency group (≤ 1.75 times per hour) (P<0.001).

Conclusions: The uEMG effectively predicts PTB after transvaginal cervical cerclage and provides a new method for clinicians to evaluate the pregnancy outcome of CI patients.

背景:早产(PTB)并发症约占新生儿死亡人数的 35%,这仍然是一个至关重要的问题。宫颈机能不全(CI)是指子宫颈无法保留妊娠,从而导致早产。宫颈环扎术是针对宫颈机能不全患者的一种有效手术,可防止宫颈进一步机械性缩短。遗憾的是,一定数量的宫颈环扎患者仍然会早产,这就迫切需要准确评估宫颈环扎患者发生 PTB 的风险。子宫肌电图(uEMG)是一种新兴的技术,它通过描述子宫活动的实际演变过程来描述子宫收缩的特征,近年来已被用于预测PTB:在这项单中心回顾性病例对照研究中,纳入了2018年1月至2022年1月期间在中山大学孙逸仙纪念医院接受宫颈环扎术和uEMG评估的单胎妊娠妇女:在接受评估的69名妇女中,观察到32例PTB。根据多变量逻辑回归分析,宫颈环扎术后PTB与既往PTB病史或中期妊娠流产(OR:2.87,95%CI:1.49-5.54)和uEMG检测到的宫缩频率(OR:2.24,95%CI:1.44-3.49)显著相关。收缩频率的 AUC(0.766,P 1.75 次/小时)和低频率组(≤ 1.75 次/小时)的 15 周(PConclusions:uEMG 可有效预测经阴道宫颈环扎术后的 PTB,为临床医生评估 CI 患者的妊娠结局提供了一种新方法。
{"title":"Use of uterine electromyography in the prediction of preterm birth after transvaginal cervical cerclage.","authors":"Haitian Xie, Menglan Zhu, Kewen Deng, Jinling Yi, Liqiong Zhu, Jianping Tan, Xiaohui Ji, Phei Er Saw, Chunwei Cao, Nengyong Ouyang, Hui Chen","doi":"10.1186/s12884-024-06779-3","DOIUrl":"10.1186/s12884-024-06779-3","url":null,"abstract":"<p><strong>Background: </strong>Preterm birth (PTB), complications of which account for approximately 35% of deaths among neonates, remains a crucial issue. Cervical insufficiency (CI) is defined as the inability of the utrine cervix to retain a pregnancy, leading to PTB. Cervical cerclage is an efficient surgery for CI patients by preventing the cervix from being further mechanically shortened. Unfortunately, a certain number of patients who had cerclage still delivered prematurely, raising the urgent need to accurately assess the risk of PTB in patients with cerclage. Uterine electromyography (uEMG) is an emerging technology that characterizes uterine contractions by describing the actual evolution process of uterine activity and has been used to predict PTB in recent years.</p><p><strong>Method: </strong>In this single-center retrospective case-control study, singleton pregnancy women who received cervical cerclage and uEMG assessment between January 2018 and January 2022 at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University were enrolled.</p><p><strong>Results: </strong>32 PTBs were observed of the 69 women who underwent assessment. Based on multivariate logistic regression analysis, PTB after cerclage was significantly associated with previous PTB history or mid-trimester pregnancy loss (OR: 2.87, 95%CI: 1.49-5.54) and contraction frequency detected by uEMG (OR: 2.24, 95%CI: 1.44-3.49). The AUC of contraction frequency (0.766, P<0.001) was observed, and the optimal cut-off value suggested by Youden Index was 1.75 times per hour. Combined with previous preterm history and cervical length, the AUC of contraction frequency reached 0.858. After stratification by contraction frequency, the median duration was 11 weeks in the high frequency group (> 1.75 times per hour) and 15 weeks in the low frequency group (≤ 1.75 times per hour) (P<0.001).</p><p><strong>Conclusions: </strong>The uEMG effectively predicts PTB after transvaginal cervical cerclage and provides a new method for clinicians to evaluate the pregnancy outcome of CI patients.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"716"},"PeriodicalIF":2.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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BMC Pregnancy and Childbirth
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